Expanded Medicaid Coverage of Gender-Affirming Treatments: New Guidance on Provision of Electrology and Medical Tattoo Services

By September 23, 2024 (30 days from policy date): (1) Billing team must update billing software to recognize CPT codes 17380, 17999, 11920, 11921, and 11922 for Maryland Medicaid claims with corresponding reimbursement rates ($90 for CPT 17380; $91.10-$142.37 for CPT 11920; $107.22-$161.06 for CPT 11921; $23.88-$48.96 for CPT 11922). (2) Verify that all Electrologists and Medical Tattoo Artists in the network are enrolled with Maryland Medicaid through ePREP under the 'PT GA - Gender Affirming Care' provider type; if not enrolled, direct them to https://eprep.health.maryland.gov or provide enrollment form at https://bitly.ws/3geNU. (3) Billing team must configure systems to use atypical NPI convention (adding '5' to nine-digit Medicaid ID) for processing claims from these providers. (4) Implement requirement that all electrolysis and medical tattoo claims include documentation of medical necessity per Gender Affirming Care Clinical Criteria (https://bit.ly/485Hpti) before submission. (5) Front desk and billing staff must ensure MCOs contract with or issue single-case agreements for Electrologists and Medical Tattoo Artists if not already in network. Claims submitted without proper enrollment, medical necessity documentation, or using incorrect provider NPIs will be denied.